Healthcare Provider Details

I. General information

NPI: 1578712105
Provider Name (Legal Business Name): SAND C CHANG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAND CHIH-ANN CHANG PH.D.

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MARKET ST FL 15
SAN FRANCISCO CA
94105
US

IV. Provider business mailing address

625 MARKET ST FL 15
SAN FRANCISCO CA
94105-3316
US

V. Phone/Fax

Practice location:
  • Phone: 415-360-3833
  • Fax: 929-529-6277
Mailing address:
  • Phone: 415-360-3833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: